I-Team: Separate Insurance Plans Causing Costly Headaches for New Parents

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DALLAS (CBSDFW.COM) – With two separate health insurance plans, Chris and Lauren Lewis weren’t worried about the hospital bill when their son, Langston, was born.

“I had insurance. My wife had insurance. We had double coverage,” Chris Lewis said.

However, the Lewises quickly discovered that having two separate insurance plans can sometimes feel like having none.

Fourteen months after Langston’s birth, the Lewises received an unexpected $4,160 bill from Baylor Scott and White Hospital for the birth of their son.

After a year of negotiations with their two insurance companies, the hospital told the Lewises that both of their insurance plans had refused to pay.

“We thought, ‘Are we going to have to pay out of pocket for this cost?’ It just doesn’t make sense,” Chris Lewis said.

When parents have two separate health insurance plans, it’s often unclear which plan will cover the newborn.

“When that happens, it creates an opportunity for each insurance company to point fingers at the other,” said Sabrina Corlette, JD, co-founder and director. Center on Health Insurance Reforms at Georgetown University. “And more often than not, the patient or consumer falls through the cracks and gets stuck with the bill.”

Lauren Lewis had health insurance with United Healthcare. The insurance company told CBS 11 News that when both parents have separate insurance, it follows the “birthday rule.” According to the rule, the parent whose birthday falls first in the calendar year is the one whose insurance is responsible for covering the birth of the child.

A spokesperson for United Healthcare told CBS 11 News: “Under Texas health insurance rules, Mr. Lewis’s insurance should cover their baby’s hospital bill because his birthday falls before the Ms. Lewis’ birthday within the calendar year. We are working with her insurer to help them pay that hospital bill.”

The “birthday rule” model has been adopted by National Association of Insurance Commissioners as a means of settling the coordination of disputes over benefits between insurers.

Under the Texas Insurance Code, state-regulated health plans, owned by 15% of Texans, are required to follow the “birthday rule.”

However, most employer-sponsored health plans, owned by 38% of Texans, are regulated by the US Department of Labor and there is no federal rule that governs what insurance coverage applies to. a birth when both parents are individually insured.

This was the case with the Chris Lewis insurance plan. He has an employer-sponsored plan administered by CareFirst BlueChoice. The Lewises said CareFirst BlueChoice told them that since they were both separately insured, the mother’s insurance plan would be responsible for covering birth costs.

CareFirst BlueChoice did not respond to questions from CBS 11 News, however, after CBS 11 News contacted Lewis’s two insurance companies, the Dallas couple said they received a call from Baylor Scott and White. A hospital representative told the family they had escalated their case and were working with CareFirst BlueChoice to cover the bill.

A hospital spokesperson told CBS 11 News, “We understand and understand the complexities that patients sometimes face, and we are working directly with (the Lewises) to help and find a solution.”

Corlette said the reason these types of coordination disputes over benefits happen is because insurance plans don’t all follow the same rules or are even regulated by the same government agency. The Texas Department of Insurance regulates fully funded state insurance plans, the U.S. Department of Labor oversees most employer-sponsored self-funded plans, and the U.S. Department of Health and Human Services regulates health plans government, such as Medicaid, Medicare, and military plans.

“In the United States, we have this very fractured health insurance system,” Corlette explained. “The onus is almost always on the individual, the consumer, to navigate the system and big trouble for you if you get it wrong.”

In July 2021, federal lawmakers introduced the Empowering Parents’ Healthcare Choice Act. The bill would give parents, with dual insurance plans, the right to choose which health plan would be the primary insurer. The bill is currently in the House subcommittee on health.

“Welcoming a child into your family should be a joyful event, free from undue stress and financial burden at the hands of insurance companies,” said U.S. Representative Sharice Davids (D-Kansas), who drafted the bill. . “This is a simple solution that gives parents power over their baby’s medical coverage, so they can make an informed choice about their family’s future.”

But even if the bill were passed, the law would not apply to all health plans. As this is a federal bill, it would only apply to federally regulated plans.

The Texas Department of Insurance encourages people to contact its helpline (1-800-252-3439) if they have trouble coordinating benefits with their health insurance plans.

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